John Chalmers DaCosta (1863-1933): restoration of the old operating table.

John Chalmers DaCosta was an influential chairman and the first Samuel D. Gross Professor of Surgery at Jefferson Medical College in Philadelphia. He was well known throughout the field as a skilled surgeon, passionate speaker, and exceptional writer. In addition to countless accomplishments during his career, DaCosta was deeply dedicated to the preservation and commemoration of surgical history. This ideology was exemplified when he set out on a mission to recover the old wooden operating table used by many of his iconic mentors including Samuel D. Gross, Joseph Pancoast, and William W. Keen. This table was originally used for surgical demonstrations and anatomy lessons in a lecture room of the Ely Building and later in the great amphitheater of the Jefferson Sansom Street Hospital. It was found forgotten in the basement of the College Building and was promptly refurbished, donned with dedicatory plaques, and returned to its honored position in the medical college. Dr. DaCosta also contributed a detailed article recalling the history of the table and the notable leaders in surgery who taught and practiced on its surface. The old table currently stands proudly in the entranceway of the Department of Surgery where it will remain as a cherished symbol of the early beginnings of surgical practice and education

Improving Advanced Care Planning Discussion and Documentation

Our goal is to improve ACP discussion and documentation in patients above the age of 65 in our Jefferson Hospital Ambulatory Practice (JHAP) resident clinic. By instituting procedural changes within the EMR and the clinic, as well as improving provider education, we hope that residents can carry out a comprehensive and streamlined discussion regarding advanced care planning. We will institute these changes over the next 3 months, and we predict that there will be an increase in ACP discussion and uploading of appropriate documentation to 50% and 25%, respectively

Organizational improvisation and the reduced usefulness of performance measurement BI functionalities

© 2018 Elsevier Inc. Firms are increasingly turning to business intelligence (BI) systems to support their management control activities, while management accounting researchers are increasingly focused on studying beneficial roles of such systems. The extant research focusses on how performance-enhancing effects of BI systems occur via enhanced managerial learning and knowledge creation. The research has however failed to consider how managerial learning and knowledge creation processes can be shaped by fundamental organizational contingencies. This paper ventures into this unexplored space to consider how organizational improvisation may moderate beneficial roles played by BI. We derive the concept of “semi-structuring heuristics” and apply it to theorize that the impact of BI functionalities on performance measurement capabilities is negatively moderated by organizational improvisation. Our hypotheses include two BI constructs (BI-planning functionality and BI-reporting functionality) and two organizational improvisation competences (strategic momentum and organizational flexibility). We test our hypotheses with partial least squares procedures using survey data from 324 top-level managers. We find that BI-planning functionality has a positive effect on performance measurement capabilities that is negatively moderated by both organizational improvisation competences. The only significant effect of BI-reporting functionality is as a positive moderator of the effect of BI-planning functionality. Organizational improvisation competences are quite common and entail managers using only “minimal forms” of performance measurement information. By implication, if the term BI “functionality” connotes usefulness and fitness-for-purpose, then this term appears a misnomer in contexts reliant on organizational improvisation

Improving the Use of Asthma Action Plans

Objectives Identify the percentage of asthmatics in Friday fellows’ clinic with an AAP in place. Determine if clinician education can increase the number of AAP created for patients

Response to rapidly changing healthcare information regarding COVID-19 with virtual journal club

Virtual twice weekly COVID-19 journal club (JC) created to optimize residency and faculty education regarding COVID-19 management, critical appraisal of new literature, and improve departmental collaboration and connection

Dexamethasone, prostaglandin A, and retinoic acid modulation of murine and human melanoma cells grown in soft agar.

The cloning efficiencies of a murine melanoma cell line (S91 CCL 53.1) and a human melanoma cell strain (C8146c) were inhibited by dexamethasone (DEX), prostaglandin A1 (PGA1), and beta-all-trans-retinoic acid (RA) in a dose-dependent manner. Murine melanoma tumor colony-forming units (MTCFU) were inhibited more than 99% by DEX (1 X 10(-7) M) and RA (1 X 10(-7) M) with a concentration needed to produce a 50% reduction in colony formation for both hormones of 5 X 10(-9) M. Combinations of DEX and RA effected a synergistic inhibition on colony formation, which was reflected by a 11/2 log reduction in the hormone concentration needed to produce a greater than 99% inhibition of colony formation. When PGA1 was added to DEX and RA, a greater than additive reduction in colony formation was observed. Human MTCFU from cell strain C8146c were inhibited more than 85% at an RA concentration of 1 X 10(-7) M, but they were reduced only to 40% of control at a DEX concentration of 1 X 10(-6) M. DEX-RA produced an additive inhibition of colony formation. Addition of submaximal amounts of PGA1 to DEX-RA combinations or to either hormone alone resulted in synergistic reduction of human MTCFU. These results demonstrated that the proliferative potential of human and murine melanomas can be simultaneously regulated by DEX, PGA1, and RA

Budgeting system style of use, organisational culture and competitive advantage in hypercompetitive environments

University of Technology, Sydney. Faculty of Business.Hypercompetitive environments have become more pervasive. This thesis addresses a gap in the literature by examining the effective use of budgeting systems and flexibility traits of organizational culture in hypercompetitive environments. Interactive use of budgeting systems has been positively linked to firm performance in 'high uncertainty' environments, but not hypercompetitive environments, which have greater intensity and unpredictability of change. Also, flexibility traits of organisational culture have been linked to firm performance in hypercompetitive settings, and to interactive use of management control systems in general. Highly interactive budgeting systems have very frequent top management involvement driving intensive strategy reformulation. To examine the effective style of use of budgeting systems for hypercompetitive conditions, the frequency and intensity of interactive use were hypothesised to be two formative sub-dimensions of budgeting system style of use. Also, flexibility values of organisational culture were hypothesised as antecedent to these two interactive control sub-dimensions. The hypotheses predicted differing relationships between these constructs in hypercompetitive and moderately competitive environments. A cross-sectional mail and web-based survey yielded 331 usable responses (a 31.1% response rate), with 32 firms in hypercompetitive environments, 259 firms in moderately competitive environments and 40 firms in stable environments. PLS structural equation modelling was used to test the theoretical model. Sub-group modelling based on the three categories of market competition was the main approach used to assess moderating effects. Only partial support for the hypotheses was found. The predicted relationships between the two interactive control sub-dimensions were not supported, affirming the latent conceptualisation of interactive control in the extant literature. Market competition was found to positively moderate the effect of interactive budgeting system use on firm performance. It was also found that flexibility culture is an important antecedent of interactive budgeting systems use, and market competition positively moderates the effect of flexibility culture on interactive budgeting systems. Dynamic capabilities theory was used to interpret the relationships, responding to appeals for a more action-oriented view of management control systems, and also providing a new perspective on management control systems and organisational learning. From the theory of dynamic capabilities, a strategically appropriate flexibility culture provides a valuable, rare, non-substitutable and inimitable resource-base, underlying an effective budgeting system capability with an isolating mechanism that confers competitive advantage. This study also contributes improved measurement scales for interactive control, and contributes empirical and theoretical insights to the under-researched organizational culture and management control systems contingency literature

Team-based Outreach to Improve Colorectal Cancer Screening Rates in an Urban Family Medicine Practice

Aims for Improvement Aim to increase CRCS rates for our resident team patients by 5% by May, 2021 Target Population (n=99): Age 50-74, due for CRCS, office visit within last 2 years, team resident listed as PCP, active on MyChart, and speak Englis

Multiple Indicator Cluster Survey 2003 in Afghanistan: Outdated Sampling Frame and the Effect of Sampling Weights on Estimates of Maternal and Child Health Coverage

Due to an urgent need for information on the coverage of health service for women and children after the fall of Taliban regime in Afghanistan, a multiple indicator cluster survey (MICS) was conducted in 2003 using the outdated 1979 census as the sampling frame. When 2004 pre-census data became available, population-sampling weights were generated based on the survey-sampling scheme. Using these weights, the population estimates for seven maternal and child healthcare-coverage indicators were generated and compared with the unweighted MICS 2003 estimates. The use of sample weights provided unbiased estimates of population parameters. Results of the comparison of weighted and unweighted estimates showed some wide differences for individual provincial estimates and confidence intervals. However, the mean, median and absolute mean of the differences between weighted and unweighted estimates and their confidence intervals were close to zero for all indicators at the national level. Ranking of the five highest and the five lowest provinces on weighted and unweighted estimates also yielded similar results. The general consistency of results suggests that outdated sampling frames can be appropriate for use in similar situations to obtain initial estimates from household surveys to guide policy and programming directions. However, the power to detect change from these estimates is lower than originally planned, requiring a greater tolerance for error when the data are used as a baseline for evaluation. The generalizability of using outdated sampling frames in similar settings is qualified by the specific characteristics of the MICS 2003—low replacement rate of clusters and zero probability of inclusion of clusters created after the 1979 census

DEVELOPMENT AND IMPLEMENTATION OF THE COGDRISK DEMENTIA RISK ASSESSMENT TOOL AND INTERACTIVE WEBSITE

We developed a comprehensive risk assessment tool for dementia – Cognitive Health and Dementia Risk Assessment (CogDrisk) and a version specifically for Alzheimer’s disease called CogDrisk-AD that could be applicable in low and high-resource settings. This tool incorporates risk and protective factors identified through systematic synthesis of observational studies that report risk ratios. Risk and protective factors included in the tool were selected on the strength of evidence as well as the availability of measures that are practicable in a range of clinical and research contexts. Seventeen risk/protective factors were identified for inclusion in the dementia algorithm to estimate the risk of dementia while sixteen factors were identified for the AD model, with an overlap in the majority of the factors. CogDrisk and the CogDrisk-AD were predictive of dementia and AD when validated across four high-quality international cohort studies. To enable the CogDrisk tool to be implemented in practice our team has developed an interactive website where individuals 18 years and above can complete the CogDrisk questionnaire, obtain a personalised risk profile, and receive feedback on their risk profile. The website was developed with the capacity to collect and store data. We anticipate that the tool can be used by members of the public, in clinical settings and as a screening or outcome measure for clinical trials